Vets Receive Care for Sub-Clinical PTSD

A new study reports that veterans who fall just below the threshold for a diagnosis of post-traumatic stress disorder (PTSD) respond to a psychotherapy regimen better than those with full PTSD.

Investigators believe the study highlights the need to recognize veterans suffering from an overlooked condition called subclinical PTSD.

Researchers from the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina (MUSC) discuss their findings in the Journal of Anxiety Disorders.

“The study shows not only that we can treat those experiencing subclinical presentations of PTSD, but also that those with subclinical PTSD may actually respond better to treatment than those with more severe forms of the disease,” says MUSC investigator Kristina Korte, Ph.D.

Researchers explain that just like patients with full PTSD, those with subclinical PTSD have experienced a traumatic event and are regularly re-experiencing it, often in nightmares or flashbacks.

Patients with full PTSD also experience hyperarousal (i.e., they are easily startled) and avoid reminders of the event, for example by withdrawing from social interaction or turning to substance abuse.

In addition re-experiencing the event, patients with subclinical PTSD may exhibit either hyperarousal or avoidance, but not both.

Psychologists began noticing this pattern more frequently in the nineties in veterans returning from the first Iraq War, and even more frequently in veterans returning from Iraq and Afghanistan in the last decade.

As researchers have learned more about these patients over time, varying and sometimes conflicting symptoms have provided an incomplete picture of the disorder and how to treat it.

The issue is complicated as those with subclinical PTSD are often excluded from clinical trials testing treatments for PTSD. That is, patients with only some symptoms of PTSD commonly aren’t included in the healthy control group or in the group with full PTSD.

As a result, there is still no standard psychotherapy for treating subclinical PTSD as there is for full PTSD.

According, the researchers devised an intuitive approach — Why not treat subclinical PTSD patients with one of the standard evidence-based psychotherapy tools already being used in PTSD patients?

To do this, they enrolled 200 patients with combat-related PTSD symptoms, identifying those with either subclinical or full PTSD.

For eight weeks, patients received intensive weekly sessions of behavioral activation and therapeutic exposure therapy, designed to lessen their PTSD symptoms by helping them safely re-experience and resolve elements of the original trauma.

Psychologists rated the patients’ PTSD symptoms and had patients rate their own symptoms before, during, and after the eight weeks.

The results were encouraging. Those with subclinical or full PTSD each experienced a real drop in PTSD symptoms after treatment. The striking result was in how much those symptoms dropped: 29 percent in those with subclinical PTSD as compared to 14 percent with full PTSD.

It may seem obvious that patients with a less severe form of PTSD would respond better to standard psychotherapy, but the implications for treatment are far-reaching.

That is, PTSD symptoms often worsen over time; as they do, treatments become less effective at reducing symptoms. In this context, subclinical PTSD could be seen as “early-stage” PTSD, in that treatment might be more effective when the disorder is caught early.

Researchers hope these early studies can move beyond men in combat to civilians of both sexes.

“It is our hope that providing treatment for subclinical PTSD could have a significant impact on the cost-effectiveness of treating this common disorder,” says Korte.

“It could lead to the prevention of more intractable forms of PTSD that can occur when subclinical PTSD goes untreated.”

Source: Medical University of South Carolina/EurekAlert
Veteran in counseling photo by shutterstock.